title: Lung recruitment maneuver during volume guarantee ventilation of preterm infants with acute respiratory distress syndrome.
abstract: Preterm infants need the achievement of adequate lung volume. Lung recruitment maneuver (LRM) is applied during high-frequency oscillatory ventilation. We investigated the effect of an LRM with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in infants conventionally ventilated for respiratory distress syndrome (RDS). Preterm infants in assisted controlled ventilation+volume guarantee for RDS after surfactant randomly received an LRM (group A) or did not (group B). LRM entailed increments of 0.2 cm H (2)O PEEP every 5 minutes, until fraction of inspired oxygen (Fi O(2))=0.25. Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve. When saturation of peripheral oxygen fell and Fi O(2) rose, we reincremented PEEP until Sp O(2) became stable. Group A ( N=10) and group B ( N=10) infants were similar: gestational age 25 ± 2 versus 25 ± 2 weeks; body weight 747 ± 233 versus 737 ± 219 g; clinical risk index for babies 9.8 versus 8.1; initial Fi O(2) 56 ± 24 versus 52 ± 21, respectively. LRM began at 86 ± 69 minutes of age and lasted for 61 ± 18 minutes. Groups A and B showed different max PEEP during the first 12 hours of life (6.1 ± 0.3 versus 5.3 ± 0.3 cm H (2)O, P=0.00), time to lowest Fi O(2) (94 ± 24 versus 435 ± 221 minutes; P=0.000) and O(2) dependency (29 ± 12 versus 45 ± 17 days; P=0.04). No adverse events and no differences in the outcomes were observed. LRM led to the earlier lowest Fi O(2) of the first 12 hours of life and a shorter O (2) dependency.
authors.affiliation: Neonatal Intensive Care Unit, V. Buzzi Children's Hospital ICP, Via Castelvetro 32, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Castoldi
authors.forename: Irene
authors.initials: I
authors.lastname: Daniele
authors.forename: Paola
authors.initials: P
authors.lastname: Fontana
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavigioli
authors.forename: Enrica
authors.initials: E
authors.lastname: Lupo
authors.forename: Gianluca
authors.initials: G
authors.lastname: Lista
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods*; D011650:Pulmonary Alveoli / Q000503:physiopathology; D011659:Pulmonary Gas Exchange; D012127:Respiratory Distress Syndrome, Newborn / Q000503:physiopathology / Q000628:therapy*; D013990:Tidal Volume / Q000502:physiology